Thromboangiitis Obliterans (Buerger Disease)
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- One of the causes of critical limb ischemia
- Nonatherosclerotic vasculitis of small- and medium-sized arteries and veins resulting in segmental occlusion of the distal extremity vasculature; caused by inflammatory thrombo-occlusive disease
- Characterized by resting pain, ischemic ulcerations, and gangrene of the digits of hands and feet
- Patients are typically young (age <50 years), male smokers.
- Synonym(s): Buerger disease
- The prevalence has decreased in North America over the past 30 years.
- Most prevalent in Eastern Europe, Mediterranean, and Asian countries
- 11 to 30/100,000 persons/year
- Predominant age: 20 to 40 years
- Predominant sex: male > female; increasingly diagnosed in women, perhaps due to increased smoking
- Estimates range from as low as 0.5% to 5.5% in Western Europe, to 45–63% in India, to 80% in Israel among those of Ashkenazi ancestry.
- Accounts for 5 and 16% of patients hospitalized for arterial occlusive disease in Europe and Japan, respectively
- 13/100,000 U.S. population
- Overall occurrence is decreasing worldwide.
Not common in the elderly
Rare in children. Consider in adolescent smokers presenting with claudication, digital ulcers, or digital gangrene.
Etiology and Pathophysiology
- Idiopathic, but it demonstrates impaired endothelium-dependent vasorelaxation and decreased peripheral sympathetic outflow. Nonendothelial mechanisms of vasodilation are intact.
- Segmental infiltration of inflammatory cells in vessel wall leads to thrombotic occlusion.
- Highly cellular and inflammatory thrombus with relative sparing of the blood vessel wall
- Smoking predisposes to occurrence.
- Genetic factors implicated
- Autoimmune component which is not fully understood
- Chronic anaerobic periodontal infection
- Greater prevalence of HLA-A54, HLA-A9, and HLA-B5
- HLA-B12 antigen may be associated with disease resistance.
- Familial cases rarely reported
- Smoking as little as 1 to 2 cigarettes daily, chewing tobacco, snuff, and nicotine replacement are all risk factors for thromboangiitis obliterans (TAO).
- Chronic anaerobic periodontal infection also may play a role in the development of TAO.